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human papillomavirus (hpv).

health canada-approved treatments: hpv

this complete guide outlines all of the treatments available for hpv in canada.

by angelica bottaro

published aug 08, 2024

last updated sep 23, 2024

10 minute read

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10 minute read

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current therapies are mainly used to manage genital warts that develop due to an hpv infection, including topical ointments. getty images

this article is for informational purposes only and is not intended to provide medical advice, diagnosis or treatment. always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. human papillomavirus, otherwise known as hpv, is a common viral infection. it is often transmitted through sexual contact, as well as skin-to-skin contact, and doesn’t usually cause symptoms. that said, when signs of infection do develop, they typically show up as warts in the genital, anal, or oral region.

in some cases, hpv doesn’t cause any harm to the body, and people are completely unaware they even have it. however, some strains, of which there are over 100, can cause cancer to develop.

the most notable cancer driven by an hpv infection is cervical cancer, but it can also cause anal, oropharyngeal, penile, vaginal, and vulvar cancer. roughly 10 per cent of women with hpv will develop cervical cancer.

the risks of developing other hpv-related types of cancer of the head and neck are 4.5x higher in men than women. hpv is also a significant contributor to penile cancer in men, and anal cancer in all sexes. according to data, it’s thought that roughly 90 per cent of all anal cancers are driven by an hpv infection.

as many as 75 per cent of people will contract the hpv infection at some point in their lives, making it a highly prevalent infection. there is no cure for hpv, and there are few viable treatments available. current therapies are mainly used to manage genital warts that develop due to an hpv infection.

prescriptions medications

the warts that develop due to an hpv infection can be treated using various prescription medications. they include:

trichloroacetic acid (tca)

tca is a form of acetic acid. it is used to treat hpv-related warts by chemically destroying proteins in the cells of the warts, shrinking them little by little until they disappear.

the dosing amount and schedule will depend entirely on personal factors, such as the size, shape, and number of warts. typically, a healthcare provider applies the topical medication directly to the lesion once per week for up to six weeks or until the warts are gone.

because of the corrosive nature of tca, some possible side effects include burning irritation and short-term pain. an allergic reaction is also possible but rare.

sources:

government of canada: anogenital warts guide: treatment and follow-up

uptodate. patient education: genital warts in women (beyond the basics)

bc centre for disease control. genital wart (hpv) treatment

memorial sloan kettering cancer center. trichloroacetic acid

rx list. trichloroacetic acid topical

bichloroacetic acid (bca)

bca is another form of acetic acid that can be used to chemically destroy warts that develop due to an hpv infection. this topical medication also breaks down proteins in the wart, leading to the death of the wart cells and, eventually, the complete removal of the wart.

as with tca, dosing will vary depending on a person’s unique circumstances. typically speaking, the dosing is similar to tca, with it being applied once per week until the warts disappear.

bca can cause skin irritation, as well as drowsiness.

sources:

government of canada: anogenital warts guide: treatment and follow-up

uptodate. patient education: genital warts in women (beyond the basics)

bc centre for disease control. genital wart (hpv) treatment

new jersey department of health and senior services. hazardous substance fact sheet dichloroacetic acid

imiquimod

imiquimod is an immune system modifier that causes the immune system to ramp up against the hpv virus in the body, leading to the resolution of warts. it is a topically applied cream.the cream should be used daily until the warts have cleared up, or for a maximum of eight weeks. if the warts have not resolved by the eight-week mark, you may need to consult with your medical provider to determine if you can keep using the medication or if something else may be required.

there are many side effects associated with the use of imiquimod, including:

skin issues, such as blisters, pain, itching, open sores, scabs, or a rash
general health issues including tiredness, weakness, body aches, pain, chills, abdominal pain, joint pain, dizziness, and fainting
urinary issues, including bladder pain, frequent urge to urinate, blood or cloudy urine, and difficult or painful urination
heart and lung issues, including tightness in the chest, wheezing, shortness of breath or trouble breathing, slow, fast, or irregular heartbeat, and chest pain
other issues, including cough, ear congestion, loss of voice, sore throat, stuffy or runny nose, cold or flu-like symptoms, blurred vision, hoarseness, swollen and painful lymph glands, severe headache, and pounding in the ears

people using this medication should avoid sunlight exposure or exposure to tanning beds, and sunscreen should be worn at all times when outdoors. sexual activity should also be avoided while using this medication unless the cream is washed off beforehand, as it can cause irritation or reduce the efficacy of contraceptives such as condoms or diaphragms. this drug is also not approved for use in those under 18.

sources:

government of canada: anogenital warts guide: treatment and follow-up

uptodate. patient education: genital warts in women (beyond the basics)

bc centre for disease control. genital wart (hpv) treatment

healthlink bc. imiquimod – topical

medline plus. imiquimod topical

mayo clinic. drugs and supplements: imiquimod (topical route)

drugs.com. imiquimod topical dosage

mayo clinic. imiquimod (topical route) precautions

podophyllotoxin

podophyllotoxin is an antimitotic, a type of drug that stops cell growth. it is used to treat hpv warts and works by preventing the wart cells from dividing and multiplying. without new cell growth, the warts eventually die, with healthy cells growing in their place.

it is a topical medication that is applied directly to the wart. as with other medicines for hpv warts, the dosing schedule may vary, but generally, people are to apply the drug to the warts twice a day for three days. if the warts are not gone by then, the same dosing can be repeated for up to five weeks or as directed by a medical provider.

there are some side effects associated with podophyllotoxin, including:

irritation to the skin
tenderness, redness, and itching in the area
pain in the area
superficial ulceration
burning and bleeding of the treated skin
dizziness or headache
vomiting

this drug should not be used if you are pregnant, nor should it be applied to open wounds or warts that are actively bleeding.

sources:

government of canada: anogenital warts guide: treatment and follow-up

uptodate. patient education: genital warts in women (beyond the basics)

bc centre for disease control. genital wart (hpv) treatment

dermnet. podophyllotoxin

sinecatechins

sinecatechins are botanical drugs used to treat warts in people with hpv. the medication is a purified version of the water extract of green tea leaves. it is unclear how these drugs work to remove warts. however, it’s thought that green tea extracts’ antiviral and antioxidative properties stimulate the immune system to rid the body of warts.

dosing will vary depending on the person and what their medical provider suggests. that said, the general schedule requires a person to apply the medication three times per day (morning, noon, and night) until the warts disappear or for a maximum of 16 weeks.

there are several side effects associated with the use of sinecatechins for warts caused by hpv, including:

redness and swelling in the area
sores or blisters
burning or itching
pain

people who are pregnant or are planning to become pregnant should avoid this drug, as should those who are breastfeeding. if other treatments have been used before sinecatechins, it’s important to wait for the skin to heal before using this medication.

sinecatechins should not be used by people with weakened immune systems or who are taking immune-suppressing drugs. sun exposure should also be avoided. sinecatechins are also not approved for use in people under 18.

sources:

government of canada: anogenital warts guide: treatment and follow-up

uptodate. patient education: genital warts in women (beyond the basics)

bc centre for disease control. genital wart (hpv) treatment

healthlink bc. sinecatechins (camellia sinensis) ointment – topical

dermnet. sinecatechins ointment

podofilox

podofilox is an antimitotic drug that blocks cell division and multiplication, stopping warts from growing. eventually, because the wart can no longer grow, it falls off. it is topically applied. you cannot use this medication for warts inside or around the rectum, vagina, or urethra, or near mucuous membranes. it is to only be used for warts that your doctor has identified for you and no other areas of the body.

the dosing schedule for podofilox will vary, depending on your healthcare provider’s instructions but is typically applied twice a day for three days before taking a break for four days. the process can be repeated for up to four weeks, or as directed by a healthcare provider.

it’s important when using the topical drug to do so properly. you should only use the applicator provided on clean skin and avoid overusing the product. the applicator tip should be wet but no product should be dripping from it. after each application, throw the applicator away and use a clean, new one during your next treatment dose. avoid sexual activity during your treatment with podofilox.

various possible side effects can develop when using this medication, including redness, itching, burning and pain in the treated area. if bleeding, or severe pain or swelling occurs, stop using this medication, wash it off your body, and call your doctor or pharmacist.

people who are allergic to any ingredients in podofilox or those who are pregnant should avoid this medication. it should also be avoided if someone is breastfeeding, unless the doctor has given the go-ahead for use, as it is unclear whether the drug can pass through breastmilk to an infant.

sources:

healthlink bc. podofilox – topical solution

bc centre for disease control. genital wart (hpv) treatment

medical procedures

other hpv-related wart treatments authorized by health canada include cryotherapy and surgical removal.

cryotherapy

cryotherapy works by freezing the warts using liquid nitrogen, essentially killing them so they can be removed. this type of surgery is typically best for warts found within the vagina, cervix, or anal cavity, as well as for urethral warts.

during the procedure, mild or moderate burning sensations may occur. in some cases, a person may also experience skin colour changes due to cryotherapy, and a scar may develop in the treated area.

during recovery, people may also experience irritation, soreness, pain, swelling, shedding dead tissue, and sores or blisters. this period typically lasts one to three weeks. it’s best to avoid sexual contact until the area is completely healed.

sources:

healthing.ca. cryotherapy for genital warts treatment overview

bc centre for disease control. genital wart (hpv) treatment

surgical removal

surgical removal for hpv warts is done using a local anesthetic to numb the area so that they can be cut off using a scalpel with minimal pain. this method is most used for warts that cannot be remedied using topical treatments, such as the ones that develop within the vagina, cervix, or anal cavity. it can also be used for urethral meatus warts.

once the wart has been removed, the wound will be stitched up and left to heal. typically, medical providers will use stitches that dissolve on their own within three weeks of having the surgery.

during the healing phase, it’s important to avoid sexual activity.

sources:

government of canada: anogenital warts guide: treatment and follow-up

uptodate. patient education: genital warts in women (beyond the basics)

lifestyle and home remedies

various lifestyle changes and home remedies can be used to prevent warts caused by hpv. they often revolve around improving the immune system’s ability to fight off the virus, which can lead to a decreased risk of developing warts. lifestyle modifications include:

eating a diet rich in antioxidants and other immune-friendly ingredients
quitting smoking
decreasing stress levels
getting regular exercise

it’s important to note that there are many over-the-counter therapies dedicated to treating warts, such as compound w®️ and dr. scholls®️, however they are not recommended for use on genital warts caused by hpv.

sources:

myhealth alberta. human papillomavirus (hpv): care instructions.

lugović-mihić l, cvitanović h, djaković i, kuna m, Šešerko a. the influence of psychological stress on hpv infection manifestations and carcinogenesis. cell physiol biochem. 2021 jul 10;55(s2):71-88. doi:10.33594/000000395

ma k, li s, wu s, zhu j, yang y. impact of smoking exposure on human papillomavirus clearance among chinese women: a follow-up propensity score matching study. tob induc dis. 2023 mar 20;21:42. doi:10.18332/tid/161026

lin hy, fu q, tseng ts, zhu x, reiss k, joseph su l, hagensee me. impact of dietary quality on genital oncogenic human papillomavirus infection in women. j infect dis. 2023 nov 11;228(10):1385-1393. doi:10.1093/infdis/jiad146

treating hpv in canada

since hpv is a viral infection, very few treatment avenues are available in the country. the current therapies are meant to improve the immune system’s response to the virus so it doesn’t cause damage or remove warts that have developed due to the virus.

it’s crucial to see your healthcare provider if you develop warts. while hpv can cause them, and treatments are available, warts are also symptoms of other sexually transmitted infections. your medical provider can help determine what is causing the warts and the best treatment route.

vaccines to treat hpv are on the horizon, but as of yet, nothing has been approved in canada for the therapeutic treatment of viral hpv infections.

angelica bottaro

angelica bottaro is the lead editor at healthing.ca, and has been content writing for over a decade, specializing in all things health. her goal as a health journalist is to bring awareness and information to people that they can use as an additional tool toward their own optimal health.

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